Staying on Track: A look at the organization used by doctors to conduct official business in medical interviews

Medical interviews are conducted with the doctor primary leading the conversation. The doctor uses specific types of questions and responses to guide the conversation to the official business that needs to be discussed. The official business is the primary purpose of the interview, such as diagnosing a patient with cancer and determining the next steps in the cancer treatment. During the medical interview, patients tend to veer off course and change the path the doctor is leading. Patients will use extended answers that provide too much detail or even tell stories that lead them off course. Doctors, in turn will often use the word “okay” to guide the patients back on track. It is apparent through the study of medical interviews that doctors are not interested in patient information that goes above what was specifically asked of them. Doctors are not interested in minor details, and are only concerned with the important details that lead them to the official business. Through the examination of medical interviews, this paper will discuss the ways doctors want and expect medical interviews to be conducted, the ways patients veer off course, and the different ways doctors use conversation to get the patients back on track.

Data and Method

Medical Interviews

The data that is looked at in this paper comes from transcriptions of first time medical visits between an Oncology doctor and a patient with a concern about cancer. This is preliminary data that was collected earlier in 2008 and will eventually be used for research in communication patterns between doctors and patients. This paper looks at four interviews that have four different doctors and four different patients. The titles of these interviews are: “Well it seems uh um what is the word ambiguous”, “Based on your presentation unfortunately is uh uh cancer”, “If only the world was that simple”, and “So it’s a recurring thing”.

Conversation Analysis

The method used to examine the medical interviews is conversation analysis. Conversation analysis is the study of “how people talk with one another in everyday casual encounter[s]” (Beach, 2008, p. 1). Conversation analysis (CA) is a method done on naturally occurring conversations between people, which makes this method of study so effective. The data collected is never “idealized or hypothetically construct[ed]”, the recordings are of actual communicative unaltered interactions (Beach, 2007, p. 83). The study of conversation gives the opportunity to explain the way humans “do things and the kinds of objects they use to construct and order their affairs” (Sacks, 1984, p. 24). Conversations are collected “by means of audio- and video-recording equipment or film” (Heritage & Atkinson, 1984, p.2). These conversations are always naturally occurring. The recordings and the” carefully produced transcriptions” of the naturally occurring conversations are then analyzed (Beach, 2008, p. 1). Studies done on conversations using conversation analysis have “proved to be highly distinctive both in methodology and findings, from a range of linguistic, social psychological and sociological approaches to the data of interaction” (Heritage, 1984, p. 234).

Patient Topic Changes in Medical Interviews

Structure of Medical Interviews

All medical interviews conducted in similar ways. The doctor will first ask questions about the “patient’s past medical conditions, the health status of parents and siblings and psychosocial and lifestyle aspects of the patient’s circumstances (Stivers & Heritage, 2001, p. 152). Second, the doctor will perform an examination of the patient. And lastly, the doctor will speak with the patient about problems, recommendations, or where to go from this point on given the information found in the medical interview. The focus of this paper is the first series of questions in medical interviews.

Comprehensive Medical History

This series of the doctor asking of questions and the patient answering is what Bates, Bickley, and Hoekelman (1995) refer to as the “comprehensive medical history” (as cited in Stivers & Heritage, 2001, p. 152). Most of the questions asked in this series are in the form of a “yes/no” question and typically include wh-inquires (Stivers & Heritage, 2001, p. 152). Heritage and Sorjonen (1994) found the questions are formatted in such a way to get a “’no problem’ response from the patient” (as cited in Stivers & Heritage, 2001, p. 153). The questions are designed to “discourage movement beyond the immediate agenda set” (Stivers & Heritage, 2001, p. 153). This infers that doctors treat minimal answers as sufficient and they prefer for the patient not to expand beyond the minimal answers. When patients stray away from briefly answering the questions, interactional problems occur. Doctors begin to demonstrate dismissive behaviors towards the patients’ answers with their responses.

Here in Example 1:“Well it seems uh um what is the word ambiguous” is a demonstration of a typical comprehensive medical history portion of a medical interview:

Example 1: “Well it seems uh um what is the word ambiguous”

1 Doctor: Okay. Um so let me kind of get some background

2 information then. You are how old.

3 Patient: Fifty.

4 Doctor: Okay. ( ) And any medical problems apart from

5 related to this.

6 Patient: No I don’t have anything.

The doctor asks the patient a series of questions related to the patients’ medical history. The patient responds as expected with short answers. Line one begins with the doctor asking a “wh-inquiry” and in line two the patient responds with a brief wh-answer. In line four the doctor responds with an “okay” which signifies a change in topic. The doctor then proceeds to ask a yes/no question in lines four and five. The patient responds in line six with a short no answer. Example 1: “Well it seems uh um what is the word ambiguous” demonstrates the way a medical interview is planned to play out by the doctor. This patient did not expand any answers, giving the doctor answers that are directly to the point. There was no behavior beyond the immediate agenda set. The doctor in turn did not display dismissive behaviors, except for the quick topic changing “okay” in lines one and four.

Below Example 1: “Based on your presentation unfortunately is uh uh cancer” is another demonstration of the basic comprehensive medical history portion of a medical interview:

Example 1: “Based on your presentation unfortunately is uh uh cancer”

1 Patient: I smoked it until I was 25 but.

2 Doctor: Okay. And how about alcohol use.

3 Patient: No.

4 Doctor: Okay. Well the concern just based on your presentation

5 unfortunately is uh uh cancer.

Here the patient responds in line one that he smoked when he was younger, which is most likely an answer to a question by the doctor as in, “Do you smoke?” Line one demonstrates a short answer to a yes/no question. The doctor responds in line two with an “okay”, signifying the topic change, and then asks about the patients alcohol use. The patient responds with the expected short “no” answer in line three. To which the doctor responds once again with an “ok” and comes out and tells the patient he thinks he has cancer in lines four and five. This example, Example 1:“Well it seems uh um what is the word ambiguous”, demonstrates the way doctors plan this part of the interview to play out. The patient gave short answers, and did not give additional information. Once again, the only dismissive behaviors demonstrated by this doctor are the “okay’s” to change the topic.